Stadnik Tadeusz W, Everaert Hendrik, Makkat Smitha, Sacré Robert, Lamote Jan, Bourgain Claire
Department of Radiology, Academisch Ziekenhuis Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium.
Eur Radiol. 2006 Oct;16(10):2153-60. doi: 10.1007/s00330-006-0276-4. Epub 2006 May 3.
Magnetic resonance (MR) imaging after ultra-small super paramagnetic iron oxide (USPIO) injection and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) for preoperative axillary lymph node staging in patients with breast cancer were evaluated using histopathologic findings as the reference standard. USPIO-enhanced MR and FDG-PET were performed in ten patients with breast cancer who were scheduled for surgery and axillary node resection. T2-weighted fast spin echo, T1-weighted three-dimensional (3D) gradient echo, T2*-weighted gradient echo and gadolinium-enhanced T1-weighted 3D gradient echo with spectral fat saturation were evaluated. MR imaging before USPIO infusion was not performed. The results were correlated with FDG-PET (acquired with dedicated PET camera, visual analysis) and histological findings. The histopathologic axillary staging was negative for nodal malignancy in five patients and positive in the remaining five patients. There was one false positive finding for USPIO-enhanced MR and one false negative finding for FDG-PET. A sensitivity (true positive rate) of 100%, specificity (true negative rate) of 80%, positive predictive value of 80%, and negative predictive value of 100% were achieved for USPIO-enhanced MR and of 80%, 100%, 100%, 80% for FDG-PET, respectively. The most useful sequences in the detection of invaded lymph nodes were in the decreasing order: gadolinium-enhanced T1-weighted 3D gradient echo with fat saturation, T2*-weighted 2D gradient echo, T1-weighted 3D gradient echo and T2-weighted 2D spin echo. In our study, USPIO-enhanced T1 gradient echo after gadolinium injection and fat saturation emerged as a very useful sequence in the staging of lymph nodes. The combination of USPIO-enhanced MR and FDG-PET achieved 100% sensitivity, specificity, PPV and NPV. If these results are confirmed, the combination of USPIO MR with FDG-PET has the potential to identify the patient candidates for axillary dissection versus sentinel node lymphadenectomy.
以组织病理学结果作为参考标准，对超小型超顺磁性氧化铁（USPIO）注射后磁共振（MR）成像和18F-氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）用于乳腺癌患者术前腋窝淋巴结分期进行了评估。对10例计划进行手术及腋窝淋巴结切除的乳腺癌患者进行了USPIO增强MR和FDG-PET检查。评估了T2加权快速自旋回波、T1加权三维（3D）梯度回波、T2加权梯度回波以及带有频谱脂肪饱和的钆增强T1加权3D梯度回波。未进行USPIO注入前的MR成像。将结果与FDG-PET（使用专用PET相机采集，视觉分析）及组织学结果进行关联。组织病理学腋窝分期中，5例患者淋巴结恶性肿瘤为阴性，其余5例为阳性。USPIO增强MR有1例假阳性结果，FDG-PET有1例假阴性结果。USPIO增强MR的灵敏度（真阳性率）为100%，特异度（真阴性率）为80%，阳性预测值为80%，阴性预测值为100%；FDG-PET的灵敏度、特异度、阳性预测值和阴性预测值分别为80%、100%、100%、80%。检测受累淋巴结最有用的序列按降序排列为：带有脂肪饱和的钆增强T1加权3D梯度回波、T2加权二维梯度回波、T1加权3D梯度回波和T2加权二维自旋回波。在我们的研究中，钆注射及脂肪饱和后的USPIO增强T1梯度回波在淋巴结分期中是一种非常有用的序列。USPIO增强MR和FDG-PET的联合应用实现了100%的灵敏度、特异度、阳性预测值和阴性预测值。如果这些结果得到证实，USPIO MR与FDG-PET的联合应用有可能确定哪些患者适合进行腋窝淋巴结清扫术与前哨淋巴结活检术。
